Objective:To investigate the surgical situations and perioperative outcome of pancreaticoduodenectomy in Jiangsu Province and the influencing factors for postoperative 90-day mortality.Methods:The retrospective case-control study was conducted. The clinicopathological data of 2 886 patients who underwent pancreaticoduodenectomy in 21 large tertiary hospitals of Jiangsu Quality Control Center for Pancreatic Diseases, including The First Affiliated Hospital of Nanjing Medical University, from March 2021 to December 2022 were collected. There were 1 732 males and 1 154 females, aged 65(57,71)years. Under the framework of the Jiangsu Provincial Pancreatic Disease Quality Control Project, the Jiangsu Quality Control Center for Pancreatic Diseases adopted a multi-center registration research method to establish a provincial electronic database for pancrea-ticoduodenectomy. Observation indicators: (1) clinical characteristics; (2) intraoperative and post-operative conditions; (3) influencing factors for 90-day mortality after pancreaticoduodenectomy. Measurement data with skewed distribution were represented as M( Q1, Q3) or M(IQR), and comparison between groups was conducted using the Mann-Whitney U test. Count data were expressed as absolute numbers or constituent ratio, and comparison between groups was conducted using the chi-square test, continuity correction chi-square test and Fisher exact probability. Maximal Youden index method was used to determine the cutoff value of continuous variables. Univariate analysis was performed using the corresponding statistical methods based on data types. Multivariate analysis was performed using the Logistic multiple regression model. Results:(1) Clinical characteristics. Of the 2 886 patients who underwent pancreaticoduodenectomy, there were 1 175 and 1 711 cases in 2021 and 2022, respectively. Of the 21 hospitals, 8 hospitals had an average annual surgical volume of <36 cases for pancreaticoduodenectomy, 10 hospitals had an average annual surgical volume of 36-119 cases, and 3 hospitals had an average annual surgical volume of ≥120 cases. There were 2 584 cases performed pancreaticoduodenectomy in thirteen hospitals with an average annual surgical volume of ≥36 cases, accounting for 89.536%(2 584/2 886)of the total cases. There were 1 357 cases performed pancrea-ticoduodenectomy in three hospitals with an average annual surgical volume of ≥120 cases, accounting for 47.020%(1 357/2 886) of the total cases. (2) Intraoperative and postoperative conditions. Of the 2 886 patients, the surgical approach was open surgery in 2 397 cases, minimally invasive surgery in 488 cases, and it is unknown in 1 case. The pylorus was preserved in 871 cases, not preserved in 1 952 cases, and it is unknown in 63 cases. Combined organ resection was performed in 305 cases (including vascular resection in 209 cases), not combined organ resection in 2 579 cases, and it is unknown in 2 cases. The operation time of 2 885 patients was 290(115)minutes, the volume of intra-operative blood loss of 2 882 patients was 240(250)mL, and the intraoperative blood transfusion rate of 2 880 patients was 27.153%(782/2 880). Of the 2 886 patients, the invasive treatment rate was 11.342%(327/2 883), the unplanned Intensive Care Unit (ICU) treatment rate was 3.087%(89/2 883), the reoperation rate was 1.590%(45/2 830), the duration of postoperative hospital stay was 17(11)days, the hospitalization mortality rate was 0.798%(23/2 882), and the failure rate of rescue data in 2 083 cases with severe complications was 6.529%(19/291). There were 2 477 patients receiving postoperative 90-day follow-up, with the 90-day mortality of 2.705%(67/2477). The total incidence rate of complication in 2 886 patients was 58.997%(1 423/2 412). The incidence rate of severe complication was 13.970%(291/2 083). The comprehensive complication index was 8.7(22.6) in 2 078 patients. (3) Influencing factors for 90-day mortality after pancreaticoduodenectomy. Results of multivariate analysis showed that age ≥ 70 years, postoperative invasive treatment, and unplanned ICU treatment were independent risk factors for 90-day mortality after pancreaticoduodenectomy ( odds ratio=2.403, 2.609, 16.141, 95% confidence interval as 1.281-4.510, 1.298-5.244, 7.119-36.596, P<0.05). Average annual surgical volume ≥36 cases in the hospital was an independent protective factor for 90-day mortality after pancreaticoduodenectomy ( odds ratio=0.368, 95% confidence interval as 0.168-0.808, P<0.05). Conclusions:Pancreaticoduodenectomy in Jiangsu Province is highly con-centrated in some hospitals, with a high incidence of postoperative complications, and the risk of postoperative 90-day mortality is significant higher than that of hospitallization mortality. Age ≥ 70 years, postoperative invasive treatment, and unplanned ICU treatment are independent risk factors for 90-day motality after pancreaticoduodenectomy, and average annual surgical volume ≥36 cases in the hospital is an independent protective factor.

Objective:To investigate the surgical efficacy and prognosis influencing factors of hilar cholangiocarcinoma based on multidisciplinary diagnosis and treatment.Methods:The retrospective cohort study was conducted. The clinicopathological data of 91 patients with hilar cholangiocarcinoma who underwent surgery in Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School from April 2004 to April 2021 were collected. There were 59 males and 32 females, aged (61±10)years. Patients who were admitted from April 2004 to March 2014 underwent traditional surgical diagnosis and treatment, and patients who were admitted from April 2014 to April 2021 underwent multidisciplinary diagnosis and treatment. Observation indica-tors: (1) surgical situations; (2) postoperative situations; (3) postoperative pathological examina-tions; (4) postoperative prognosis analysis; (5) influencing factors of postoperative prognosis. Follow-up was conducted using telephone interview and outpatient examination. Patients were followed up once every 6 months after surgery to detect survival. The follow-up was up to April 2023. Measure-ment data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the independent sample t test. Measurement data with skewed distribution were represented as M(range), and comparison between groups was conducted using the Mann-Whitney U test. Comparison of ordinal data was conducted using the rank sum test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test or Fisher exact probability. The Kaplan-Meier method was used to draw survival curve and calculate survival rate. The Log-Rank test was used for survival analysis. Univariate and multivariate analyses were conducted using the COX proportional hazard model. Results:(1) Surgical situations. Of the 91 patients, there were 65 cases receiving hemi- or expanded hemi-hepatectomy, 13 cases receiving tri-hepatectomy, 9 cases receiving partial hepatectomy, 4 cases receiving extrahepatic bile duct resection. There were 24 cases receiving combined vein resection and reconstruction, 8 cases receiving combined pancreaticoduodenectomy, 6 cases receiving com-bined hepatic artery resection and reconstruction, including 24 cases receiving extended radical surgery (tri-hepatectomy, hepatic artery resection and reconstruction, hepatopancreaticoduodenec-tomy). The operation time, volume of intraoperative blood loss and intraoperative blood transfusion rate of 91 patients was (590±124)minutes, 800(range, 500?1 200)mL and 75.8%(69/91), respectively. Of the 91 patients, cases receiving extended radical surgery, the volume of intraoperative blood loss were 4, 650(range, 300?1 000)mL in the 31 patients who were admitted from April 2004 to March 2014, versus 20, 875 (range, 500?1 375)mL in the 60 patients who were admitted from April 2014 to April 2021, showing significant differences between them ( χ2=4.39, Z=0.31, P<0.05). (2) Post-operative situations. The postoperative duration of hospital stay and cases with postoperative infectious complications were (27±17)days and 50 in the 91 patients. Cases with abdominal infection, cases with infection of incision, cases with bacteremia and cases with pulmonary infection were 43, 7, 5, 8 in the 91 patients. One patient might have multiple infectious complications. Cases with bile leakage, cases with delayed gastric emptying, cases with chylous leakage, cases with liver failure, cases with pancreatic fistula, cases with intraperitoneal hemorrhage, cases with reoperation, cases dead during the postoperative 90 days were 30, 9, 9, 6, 5, 3, 6, 3 in the 91 patients. Cases with abdominal infection was 10 in the 31 patients who were admitted from April 2004 to March 2014, versus 33 in the 60 patients who were admitted from April 2014 to April 2021, showing a significant difference between them ( χ2=4.24, P<0.05). Cases dead during the postoperative 90 days was 3 in the 31 patients who were admitted from April 2004 to March 2014, versus 0 in the 60 patients who were admitted from April 2014 to April 2021, showing a significant difference between them ( P<0.05). (3) Post-operative pathological examinations. Of the 91 patients, cases with Bismuth type as type Ⅰ?Ⅱ, type Ⅲ, type Ⅳ, cases with T staging as Tis stage, T1 stage, T2a?2b stage, T3 stage, T4 stage, cases with N staging as N0 stage, N1 stage, N2 stage, cases with M staging as M0 stage, M1 stage, cases with TNM staging as 0 stage, Ⅰ stage, Ⅱ stage, Ⅲ stage, ⅣA stage, ⅣB stage, cases with R 0 radical resection, cases with R 1 or R 2 resection were 15, 46, 30, 1, 9, 25, 30, 26, 49, 36, 6, 85, 6, 1, 7, 13, 58, 6, 6, 63, 28. Cases with R 0 radical resection, cases with R 1 or R 2 resection were 15, 16 in the 31 patients who were admitted from April 2004 to March 2014, versus 48, 12 in the 60 patients who were admitted from April 2014 to April 2021, showing a significant difference between them ( χ2=9.59, P<0.05). (4) Postoperative prognosis analysis. Of the 91 patients, 3 cases who died within 90 days after surgery were excluded, and the 5-year overall survival rate and median overall survival time of the rest of 88 cases were 44.7% and 55 months. The 5-year overall survival rate was 33.5% in the 28 patients who were admitted from April 2004 to March 2014, versus 50.4% in the 60 patients who were admitted from April 2014 to April 2021, showing a significant difference between them ( χ2=5.31, P<0.05). Results of further analysis showed that the corresponding 5-year overall survival rate of cases without lymph node metastasis was 43.8% in the 16 patients who were admitted from April 2004 to March 2014, versus 61.6% in the 31 patients who were admitted from April 2014 to April 2021. There was a significant difference in the 5-year overall survival rate between these patients without lymph node metastasis ( χ2=3.98, P<0.05). The corresponding 5-year overall survival rate of cases with lymph node metastasis was 18.5% in the 12 patients who were admitted from April 2004 to March 2014, versus 37.7% in the 29 patients who were admitted from April 2014 to April 2021. There was no significant difference in the 5-year overall survival rate between these patients with lymph node metastasis ( χ2=2.25, P>0.05). (5) Influencing factors of postoperative prognosis. Results of multivariate analysis showed that poorly differentiated tumor and R 1 or R 2 resection were inde-pendent risk factors influencing prognosis after surgical treatment of hilar cholangiocarcinoma ( hazard ratio=2.62, 2.71, 95% confidence interval as 1.30?5.29, 1.30?5.69, P<0.05). Conclusions:Compared with traditional surgical diagnosis and treatment, treatment of hilar cholangiocarcinoma based on multidisciplinary diagnosis and treatment can expand surgical indications, reduce proportion of dead patients within 90 days after surgery, improve proportation of radical resection and long-term survival rate. Poorly differentiated tumor and R 1 or R 2 resection are independent risk factors influencing prognosis after surgical treatment of hilar cholangiocarcinoma.

BACKGROUND: Cholecystectomy is a standard surgery for patients suffering from gallbladder diseases, while the causal effects of cholecystectomy on colorectal cancer (CRC) and other complications are still unknown. METHODS: We obtained genetic variants associated with cholecystectomy at a genome-wide significant level ( P value <5 × 10 -8 ) as instrumental variables (IVs) and performed Mendelian randomization (MR) to identify the complications of cholecystectomy. Furthermore, the cholelithiasis was also treated as the exposure to compare its causal effects to those of cholecystectomy, and multivariable MR analysis was carried out to judge whether the effect of cholecystectomy was independent of cholelithiasis. The study was reported based on Strengthening the Reporting of Observational Studies in Epidemiology Using Mendelian Randomization guidelines. RESULTS: The selected IVs explained 1.76% variance of cholecystectomy. Our MR analysis suggested that cholecystectomy cannot elevate the risk of CRC (odds ratio [OR] =1.543, 95% confidence interval [CI]: 0.607-3.924). Also, it was not significant in either colon or rectum cancer. Intriguingly, cholecystectomy might decrease the risk of Crohn's disease (OR = 0.078, 95% CI: 0.016-0.368) and coronary heart disease (OR = 0.352, 95% CI: 0.164-0.756). However, it might increase the risk of irritable bowel syndrome (IBS) (OR = 7.573, 95% CI: 1.096-52.318). Cholelithiasis could increase the risk of CRC in the largest population (OR = 1.041, 95% CI: 1.010-1.073). The multivariable MR analysis suggested that genetic liability to cholelithiasis could increase the risk of CRC in the largest population (OR = 1.061, 95% CI: 1.002-1.125) after adjustment of cholecystectomy. CONCLUSIONS The study indicated that cholecystectomy might not increase the risk of CRC, but such a conclusion needs further proving by clinical equivalence. Additionally, it might increase the risk of IBS, which should be paid attention to in clinical practice.
Humans ; Mendelian Randomization Analysis ; Irritable Bowel Syndrome ; Colorectal Neoplasms/genetics* ; Cholelithiasis/complications* ; Cholecystectomy/adverse effects* ; Genome-Wide Association Study ; Polymorphism, Single Nucleotide

Objective:The tumor-stroma ratio(TSR)is considered an independent prognostic factor for gastric cancer.Traditionally,TSR as-sessments have relied on the visual evaluation of surgical specimens,which is a method that lacks objectivity.This study was conducted to investigate whether the TSR in preoperative biopsy specimens can be automatically quantified using deep learning methods and whether the TSR value can be used to predict the efficacy of neoadjuvant chemotherapy(NAC)in patients with gastric cancer.Methods:In total,148 preoperative biopsy slides and 43 surgical resection slides from patients with gastric cancer who underwent NAC treatment at Yunnan Can-cer Hospital between March 2013 and March 2020 were used in the study.Tumor region segmentation and epithelial-stromal segmentation models were developed.The surgical resection slides were used to trained and evaluate the model,and the biopsy slides were used to test their predictive abilities.The TSR values were determined on the basis of the intersection of predictions from both models.The postoperat-ive pathological tumor regression grade(TRG)was used to categorize patients into good responders(TRG 0-1)and poor responders(TRG 2-3).Univariate and multivariate Logistic regression analyses were conducted to determine the correlation between the TSR value and the ef-ficacy of NAC in gastric cancer.Results:The intersection over union(IOU)value was 0.94 for the tumor tissue segmentation model and 0.88 for the epithelial-stromal segmentation model.Using cutoff values of 44.93％and 70.22％,patients were classified into low,intermediate,and high TSR groups.The proportion of good responders was significantly different among these groups(P＜0.05).Multivariate Logistic re-gression analysis indicated that the TSR was an independent predictor of NAC response in gastric cancer(OR=0.10,95％CI:0.03-0.32).When the TSR three-category classification was added as a predictor of treatment response alongside conventional clinical information,the area under curve(AUC)increased from 0.71 to 0.85.Conclusions:This deep learning model is capable of automatically segmenting tumor,epi-thelial,and stromal regions based on pathological slides,accurately calculating TSR value,and predicting the efficacy of NAC on the basis of the automatically computed TSR values.

Objective:To investigate the effect of logistic regression model based on virtual touch tissues quantification (VTQ) and fibrosis index based on four factors (FIB-4) in assessing impaired liver reserve function (LFR) in hepatic surgery patients before surgical resection.Methods:From January 2016 to October 2018, 173 patients including 135 males and 38 females with the mean age of 58.6 years old, scheduled for potential hepatectomy in Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, were enrolled in our retrospective study. According to indocyanine green retention test at 15 minutes (ICG R15), the patients were divided into two groups, LFR-impaired group ( n=11, ICG R15≥20%) and control group ( n=162, ICG R15 < 20%). VTQ, FIB-4, platelet count and other parameters were compared between two groups. The multivariate logistic regression model was used to establish a risk model to access the impaired LFR. Receiver operating characteristic (ROC) curve was used to analyze the efficacy of each parameter in LFR-impaired. Results:The platelet count in LFR-impaired group was lower than that in control group, VTQ and FIB-4 were higher than that in control group (all P<0.05). Logistic regression showed that VTQ ( OR=4.382, 95% CI: 1.380-13.918)) and FIB-4 ( OR=2.112, 95% CI: 1.342-3.325) were risk factors for LFR-impaired. The final prediction model of LFR-impaired group was Logit (P)=-6.185+ 0.748×FIB-4+ 1.477×VTQ. The cut-off point (sensitivity, specificity, accuracy) of logistic model, FIB-4 and VTQ were 0.098 (72.8%, 90.1%, 89.0%), 0.990 (90.9%, 79.0%, 79.8%) and 1.8 m/s (81.8%, 77.8%, 78.0%), respectively. The specificity, accuracy of logistic model was higher than FIB-4 or VTQ. Conclusions:Logistic regression model based on VTQ and FIB-4 may improve the specificity and accuracy in the diagnosis of significant LFR impairment. VTQ can further assist clinicians in preoperative evaluation of LFR.

Objective To explore the early prognosis and the risk factors of delayed graft function (DGF) of the recipients undergoing liver transplantation from donor liver with moderate-to-severe steatosis. Methods Clinical data of 475 donors and 475 recipients undergoing liver transplantation from donor liver of organ donation after citizen's death were retrospectively analyzed. According to the classification criteria of steatosis proposed by Australia National Liver Transplantation Unit (ANLTU), all recipients were divided into the S0 group (no steatosis, n=308), S1 group (mild steatosis, n=97), S2 group (moderate steatosis, n=52) and S3 group (severe steatosis, n=18), respectively. The early postoperative death and incidence of postoperative complications were statistically compared among each group. The risk factors from donors, recipients and operation leading to DGF were analyzed by univariate and multivariate logistic regression models. Results The incidence of postoperative DGF in the S2 and S3 groups was significantly higher than that in the S1 and S0 groups (all P < 0.05). The incidence of postoperative DGF in the S3 group was remarkably higher than that in the S2 group (P < 0.05). The early postoperative fatality, the incidence of primary nonfunction (PNF) of the transplant liver, postoperative bleeding, infection, biliary complications and vascular complications did not significantly differ among each group (all P > 0.05). Univariate regression analysis showed that severe steatosis of donor liver, long cold ischemia time, high model for end-stage liver disease (MELD) score and tumors of the recipients before operation were the risk factors of DGF (all P < 0.05). Multivariate logistic regression analysis demonstrated that moderate-to-severe steatosis of donor liver, cold ischemia time > 8 h and MELD score > 30 of the recipients were the independent risk factors for early postoperative DGF. Conclusions The early-stage incidence of DGF after adult liver transplantation from donor liver with moderate-to-severe steatosis is high, whereas it does not affect the early survival rate of the recipients. The selection of donor liver with moderate-to-severe steatosis should be considered in combination with cold ischemia time of the donors and MELD score of the recipients before operation, etc.

AIM: To analyze the difference of endonuclease domain containing 1 (ENDOD1) expression be-tween benign prostatic hyperplasia ( BPH ) tissues and prostate cancer ( PCa ) tissues and to investigate the effect of ENDOD1 on the biological function of human prostate cancer cells .METHODS: The BPH samples ( n=20 ) and PCa samples (n=21) were processed and analyzed according to the instruction of immunohistochemical (IHC) staining.The mRNA and protein levels of ENDOD 1 in the normal prostate epithelial cells and prostate cancer cells were evaluated by RT -qPCR and Western blot , respectively .The recombinant plasmids pCMV-N-Flag-ENDOD1 was constructed and was trans-fected into the human prostate cancer cells .The proliferation , apoptosis , migration and invasion abilities of the prostate cancer cells were evaluated by MTT assay , flow cytometry, Transwell migration and Matrigel invasion assays , respectively. RESULTS:The analysis of variance of the immunoreactivity score showed that PCa tissues with high Gleason score dis -played significantly lower ENDOD1expression than that with low Gleason score and BPH (P<0.05).The expression of ENDOD1 at mRNA and protein levels in PC3 cells and DU145 cells was significantly lower than that in the LNCap cells (P<0.05).The proliferation of DU145 transfected with ENDOD1 was inhibited.The flow cytometry indicated that ENDOD1 over-expression in the DU145 cells resulted in a notable increase in G0/G1 phase arrest (P<0.05), but the ap-optotic rates showed no statistical difference .The results of Transwell assay showed that migration and invasion abilities of the cells were also inhibited after transfection with over-expressing ENDOD1 plasmid (P<0.05).CONCLUSION: The expression of ENDOD1 significantly decreased in prostate cancer with high Gleaon score .Meanwhile, the ENDOD1 is spe-cifically down-regulated in androgen independent prostate cancer (AIPC) cell lines.Over-expression of ENDOD1 remark-ably inhibits the proliferation , migration and invasion abilities of AIPC .

Objective To study the correlation between male primary varicose vein of the lower extremity and varicocele.Methods 100 male patients with varicose vein of the lower extremity were compared with 100 male adults without varicose vein of the lower extremity for the prevalence of varicocele by using ultrasonography.Results There is no difference of demographic data between the two groups (t =1.78,P ＞ 0.05).There were 49 (49.0％) patients found with varicoele in study group compared with 19 (19.0％) patients with varicoele in control group (x2 =20.05,P ＜ 0.01).We compared the rate of varicoele and the mean diameter of spermatic vein between the patients having reflux in the saphenofemoral junction or not,and found there was no statistical difference between themn (rate of varicose P ＞ 0.05,diameter P ＞ 0.05).In patients with both lower extremity varicose vein and varicocele there was a linear correlation between spermatic vein diameter and that of varicose vein (rs =0.407 2,P ＜ 0.01).When patients in study group were classified into six grades by Clinical-Etiology-Anatomy-Pathophysiology (CEAP) trend chi-square found no difference in the incidence of varicoele (x2 =0.879 8,P ＞ 0.05),nor the mean diameter of spermatic vein in different grades (F =1.59,P ＞ 0.05).Conclusion There is a correlation between varicose vein of the lower extremity and the pathogcnesis of varicocele.

Objective To study the development characteristics of cavum sepit pellucidun (CSP)in prematures,neonates,infants and adults with MRI.Methods Brain MR images of different subjects including 141 prematures,106 neonates,171 infants and 35 046 adults were observed to determine the incidence and shape of CSP,and to measure its transverse diameter.Results CSP incidences were 100% (141/141)in prematures,97.17% (103/106)in neonates,2.26%(4/177)in infants and 0.82% (287/35 046)in adults respectively,and the CSP was cylinder (44.00%)or triangle in shape (56.00%)in prematures,triangle (76.40%)or fissure in shape (23.60%)in neonates.For infants or adults,each shape accounted for about a third of three kinds of shape respectively.Its mean transverse diameters were 5.7 mm in prematures,4.1 mm in neonates,13.3 mm in infants and 14.3 mm in adults respectivity.Conclusion CSP has different performances at development periods in human being brain.Most close after birth,while fewer remain in the whole life.

Objective To evaluate the viability of residual tumor after insufficient thermal ablation of rabbit VX2 liver tumor and investigated the efficacy of sorafenib as an adjuvant therapy.Methods Twenty-one rabbits were implanted with VX2 tumor to establish orthotopic liver tumor models.They were allocated randomly into 3 groups:control (n =7),ablation (n =7),and combination treatment (n =7).Microwave coagulation therapy was conducted with 20 W for 1 min and viable tumor tissue remained at the periphery.A laparotomy was performed in the control group.Sorafenib was given at 20 mg/kg/d during the following 10 days in the combination treatment group,and saline was given to the control and ablation group.Tumor volume was recorded before and after treatment,immunohistochemistry detected CD31 and proliferating cell nuclear antigen (PCNA) expression,and the micro-vessel density (MVD) and proliferation index (PI) were calculated accordingly.Results Ten days after insufficient ablation,tumor volume of the ablation group was larger than that of the control group (P ＜0.05).The MVD and PI of residual tumor were higher compared with those of the control group (P ＜ 0.05).With adjuvant therapy of sorafenib after insufficient ablation,tumor volume showed a decrease on the 10th day compared with tumors undergoing insurfficient ablation alone (P ＜ 0.05).The MVD and PI of residual tumor were lower than those of the ablation group (P ＜0.05).Conclusion Insufficient thermal ablation promotes residual tumor progression,but adjuvant therapy of sorafenib serves as an effective way to suppress the overgrowth and neovasculation of the residual tumor.